Provider Demographics
NPI:1871505792
Name:CIASULLO, DAMIEN PETER (DC)
Entity Type:Individual
Prefix:DR
First Name:DAMIEN
Middle Name:PETER
Last Name:CIASULLO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6809 GERMANTOWN AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19119-2112
Mailing Address - Country:US
Mailing Address - Phone:215-844-4400
Mailing Address - Fax:215-844-4070
Practice Address - Street 1:6809 GERMANTOWN AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19119-2112
Practice Address - Country:US
Practice Address - Phone:215-844-4400
Practice Address - Fax:215-844-4070
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA008019111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU84664Medicare UPIN
PA047183UN5Medicare ID - Type UnspecifiedMEDICARE #